Chest Compliance Directed Chest Compressions

ABSTRACT

Among other things, in one aspect, we describe a system for assisting with cardiopulmonary resuscitation (CPR). The system includes at least one sensor; and one or more processors configured for calculating a chest compliance relationship based on data received from the at least one sensor, and determining a neutral position of chest compression based at least in part on a feature of the chest compliance relationship. The system can take the form of an active compression-decompression device.

CLAIM OF PRIORITY

This application is a continuation of U.S. application Ser. No.15/267,255, filed on Sep. 16, 2016, which claims benefit of priorityunder 35 USC § 119(e) to U.S. Provisional Application Ser. No.62/221,167, filed on Sep. 21, 2015, the entire contents of which arehereby incorporated by reference.

TECHNICAL FIELD

This invention relates to the field of cardiac resuscitation, and inparticular to devices for assisting rescuers in performing activecompression and decompression of the chest during cardio-pulmonaryresuscitation (CPR).

BACKGROUND

Worldwide, sudden cardiac arrest is a major cause of death and is theresult of a variety of circumstances, including heart disease andsignificant trauma. In the event of a cardiac arrest, several measureshave been deemed to be essential in order to improve a patient's chanceof survival. These measures, termed Cardiopulmonary Resuscitation (CPR)must be taken as soon as possible to at least partially restore thepatient's respiration and blood circulation. CPR is a collection oftherapeutic interventions designed to both provide blood flow viaexternal manipulation of the external surface of the patient (e.g.thorax, abdomen, legs) as well as oxygenate the patient's blood,typically via delivery of external oxygen and other gases to thepatient's lungs. One common technique, developed approximately 30 yearsago, is chest compression.

Chest compression during CPR is used to mechanically support circulationin subjects with cardiac arrest, by maintaining blood circulation andoxygen delivery until the heart is restarted. The victim's chest iscompressed by the rescuer, ideally at a rate and depth of compression inaccordance with medical guidelines, e.g., the American Heart Association(AHA) guidelines. Other key chest compression parameters are velocity ofdecompression or release velocity, and the duty cycle of compression anddecompression phases.

Traditional chest compressions are performed by the rescuer by layingthe patient on their back, placing the rescuer's two hands on thepatient's sternum and then compressing the sternal area downward towardsthe patient's spine in an anterio-posterior direction with an applieddownward force. The rescuer then raises their hands upwards and releasesthem from the patient's sternal area, and the chest is allowed to expandby its natural elasticity that causes expansion of the patient's chestwall. The rescuer then repeats this down-and-up motion in a cyclical,repetitive fashion at a rate sufficient to generate adequate blood flow.The downward phase of the compression is typically referred to as thecompression phase. The upward-going portion of the compression cycle istypically referred to as the release or decompression phase.

One key step for creating blood flow through the heart is to release thechest adequately after each chest compression. The chest should bereleased sufficiently to enhance negative pressure in the thoraciccavity, to facilitate venous filling of the ventricles of the heart andincrease blood volume available to be distributed during the next chestcompression. If the chest is not released adequately, venous return andright atrial filling will be hindered.

In order for the rescuer to properly deliver chest compressions, it isbeneficial to be able to provide real-time feedback to rescuer's thatallow them to adjust the various aspects of their compressions todeliver optimal care to the patient. Systems such as the ZOLL MedicalRealCPRHelp (Chelmsford Mass.) use accelerometers or other motionsensors to measure the motion of the patient's sternum and providereal-time feedback on chest compression parameters such as thosementioned above. The sternal motion is also stored in the monitoringdevice—a defibrillator or even a smartphone, smartwatch, etc.—for reviewby the rescuer or other medical personnel. Some systems use just forcesensors to estimate the chest compression motion parameters by assumingsome nominal value for the patient's chest compliance and calculating anestimated displacement from the measured force.

In order to increase cardiopulmonary circulation induced by chestcompression, a technique referred to as active compression-decompression(ACD) has been developed. According to ACD techniques, an applicatorbody is interposed between the rescuer's hands and the patient'ssternum, the applicator body further being affixed via a suction cup orcups or self-adhesive pad. During the compression phase, the rescuerpresses against the applicator pad to compress the patient's sternum, aswith standard chest compressions. Unlike standard chest compressionswhere the chest passively returns to its neutral position during therelease phase, with ACD, the rescuer actively pulls upward duringrelease or decompression phase. This active pulling upward, or activedecompression, increases the release velocity and results in increasednegative intrathoracic pressure, as compared to standard chestcompressions, and induces enhanced venous blood to flow into the heartand lungs from the peripheral venous vasculature of the patient. Devicesand methods for performing ACD to the patient are described in U.S. Pat.Nos. 5,454,779 and 5,645,552.

During ACD chest compression, the patient's sternum is typically pulledupward beyond the neutral position of the sternum during thedecompression phase, where “neutral” is defined as the steady-stateposition of the sternum when no force—either upward or downward—isapplied by the rescuer. As will be described below with respect to FIG.3, both the compression phase and decompression phase will both have aportion of their motion during which the sternum is pulled upward beyondthe neutral position—what we term the “Elevated” phase. There are thus 4phases: Compression: Elevated (CE); Compression: Non-elevated (CN);Decompression: Elevated (DE); Decompression: Non-elevated (DN). It isbeneficial to be able to provide real-time feedback to the rescuer onthese different phases of the Active Compression Decompression cycle.

During the time-course of a resuscitation, the patient's chest wall will“remodel” as a result of the repetitive forces applied to the chestwall—sometimes exceeding 100 lbs of force needed to sufficientlydisplace the sternum for adequate blood flow—and the resultantrepetitive motion. Chest compliance will typically increasesignificantly as the sternum/cartilage/rib biomechanical system issubstantially flexed and stressed. Thus the amount of force needed todisplace the sternum to the proper compression and decompression depthswill also change significantly. During the course of chest wallremodeling, the anterior-posterior diameter—the distance between thesternum and the spine—will also very frequently alter substantially,meaning the neutral position will change over the course of theresuscitation. An accurate measure of the neutral position is needed atall times during the course of the resuscitation; thus, taking aninitial position measurement at the beginning of the resuscitation andassuming a constant neutral position over the course of theresuscitation will not be sufficient to generate accurate estimations ofthe motion parameters of the CE, CN, DE and DN phases of the compressioncycle. For instance, it is of particular value to be able to measure themotion parameters and forces delivered during the DE phase and CN phasesindependently from each other and to the exclusion of the CE and DNphases.

Some ACD systems use a force sensor interposed between the rescuer'shands and the patient's sternum, where compressions are being delivered,to monitor the relaxation phase of the chest compression. However, thesternal force for a chest compression does not correlate to blood flow,nor does it correlate with sternal motion or chest wall dynamics. Eachpatient requires a unique amount of force to achieve the samecompression of the sternum and the cardiopulmonary system due to thewidely varying compliances of individual patients' chests. Further, aforce sensor is generally not able to measure motion of the sternum—akey parameter for understanding the quality of the chest compressiondelivered and the amount of venous return.

Other chest compression monitoring systems that utilize motion-sensingsystems such as accelerometers; for instance, the ZOLL MedicalRealCPRHelp (Chelmsford Mass.), are able to measure motion parameterssuch as velocity and displacement. However, because of the way that ACDcompressions are delivered, existing systems are limited in theirability to distinguish between the motions of the Elevated andNon-elevated phases.

SUMMARY

Among other things, in one aspect, we describe a system for assistingwith cardiopulmonary resuscitation (CPR). The system includes at leastone sensor; and one or more processors configured for calculating achest compliance relationship based on data received from the at leastone sensor, and determining a neutral position of chest compressionbased at least in part on a feature of the chest compliancerelationship. The system can take the form of an activecompression-decompression device.

The system has a number of advantages. For example, the system canprovide feedback (e.g., on a user interface) that allows a rescuer tounderstand the effectiveness of the CPR treatment he or she isadministering. The rescuer can then adjust the forces that he or she isapplying during the CPR treatment and receive feedback confirmingwhether the adjustment is improving the effectiveness of the treatment.Depending on the implementation, the feedback can be provided by a CPRdevice, or transmitted to a second device external to the CPR device. Inthis way, it is more likely the CPR treatment will be effective atresuscitating the victim, and less likely that the CPR treatment willcause injury to the victim.

The details of one or more implementations are set forth in theaccompanying drawings and the description below. Other features,objects, and advantages will be apparent from the description anddrawings, and from the claims.

DESCRIPTION OF DRAWINGS

FIG. 1 is shows a device that assists a user with performing activecompression-decompression (ACD) CPR on a patient.

FIG. 2 represents the change in shape of the chest of a patient.

FIG. 3 represents signals recorded during CPR.

FIG. 4 is a block diagram of components of the ACD device shown in FIG.1.

FIG. 5 shows an example graph including a chest compliance curve.

FIGS. 6A and 6B show graphs of stiffness curves.

FIG. 7 shows an example graph including a chest compliance curve thatforms a hysteresis loop.

FIG. 8 shows an example of a user interface.

FIG. 9 shows a state transition diagram of a chest compression cycle.

FIG. 10 shows a trend graph of chest remodeling.

FIG. 11 is a block diagram of an example computer system.

Like reference symbols in the various drawings indicate like elements.

DETAILED DESCRIPTION

FIG. 1 shows a device 100 that assists a user 102 with performing activecompression-decompression (ACD) CPR on a patient 104 who is beingrescued from a cardiac event. The device 100 includes a user interface106 that provides feedback to the user 102 (sometimes referred to as arescuer) about the effectiveness of the CPR that the user 102 isadministering. The feedback is determined based on part on informationabout chest compliance of the patient 104 (sometimes referred to as avictim) as measured by the device 100 (sometimes referred to as an ACDdevice).

Chest compliance is a measure of the ability of the chest to absorb anapplied force and change shape in response to the force. In the contextof CPR, information about chest compliance can be used to determine howforce can be applied to the chest of a patient in a way that will beeffective at resuscitating the patient. Ideally, the force applied tothe patient will be sufficient to create a vacuum within the heart thatcauses blood to flow. However, if the force is not sufficient to createthis vacuum, CPR will not be effective and the patient will die orotherwise deteriorate. Further, if the force is not applied correctly oris too great, then the patient may be injured. Feedback provided to theuser 102 can be enhanced by determining a neutral position of chestcompression and using information about the administration of the CPRtreatment to give the user 102 guidance that will improve the chances ofsuccess of the CPR treatment.

The neutral position location or other phase transition points may bedetermined by methods described herein. The neutral position may also beconsidered the position at which zero force or pressure is exerted bythe rescuer during ACD compressions. Because of so-called chestremodeling that occurs during chest compressions, this zero-forceneutral position may change over the course of resuscitation efforts, asthe anterior/posterior diameter of the patient will decrease aftermultiple compression cycles. Alternatively, the neutral positionlocation may be simply the initial position of the sternum prior toinitiation of chest compressions.

In some implementations, the device 100 determines (e.g., calculates) achest compliance relationship that is then used to determine whatfeedback to provide the user. For example, the device 100 may calculatea mathematical relationship between two variables, such as displacementand force, related to chest compliance. The device 100 can then identifyone or more features of this relationship that can be used to determineinformation about the CPR treatment. Once the information about the CPRtreatment is determined, the device 100 can determine what feedback toprovide to the user, e.g., feedback about the progress of the CPRtreatment, feedback related to chest compression depth when in thenon-elevated portion of the chest compression cycle or feedback relatedto the force when in the elevated portion of the chest compressioncycle.

In some examples, the information about the CPR treatment can includeinformation about the patient such as a neutral position of chestcompression. In some implementations, the chest compliance relationshipcan be thought of or represented as a curve, e.g., a curve of a graphrepresenting the relationship. In some implementations, the chestcompliance relationship can be stored as data such as a table ofmeasured values (e.g., values for displacement and force at multipletime indices).

As shown in FIG. 1, the device 100 has handles 108, 110 that the user102 grips to apply force. The device 100 also has a suction cup 112 thattends to keep the device 100 in contact with the chest 114 of thepatient 104. When the user applies upward force using the device 100,the chest 114 of the patient will be pulled upward in response due tothe suction of the suction cup 112. This upward force creates a negativepressure within the thorax of the patient during the release phase of aCPR treatment. A device that creates a negative pressure in this way issometimes referred to as an impedance threshold device (ITD) 116.

In some examples, the feedback given to the user 102, e.g., on the userinterface 106, guides the user in the way that the user 102 iscompressing the chest using the device 100. For example, the userinterface 106 can include a visual indication of the effectiveness ofthe upward and downward portions of the compression cycle. Parametersfor which feedback can be provided include compression depth andcompression release velocity. In this way, the user 102 can adjust thevarious elements of their compression activity in response to thefeedback.

As a real-world example, the user interface 106 may display a graph thatshows whether the upward or downward forces are too strong, or notstrong enough, and then the user 102 can adjust accordingly. Forexample, if the device 100 determines that the depth of the compressionphase is not sufficient for an effective CPR treatment, the device 100can display feedback indicating that the depth of the downward motion isnot meeting a threshold of effectiveness. In some implementations, thedevice 100 can determine whether the upward or downward forces are toostrong or not strong enough based on an estimate of the neutral positionof chest compression of the patient 104. The neutral position of chestcompression of the patient 104 serves as an inflection point that can beused to differentiate the movement of the chest on upward strokes frommovement of the chest on downward strokes and generate specificmeasurements for the CE, CN, DN and DE phases of the compression cycle.

Because the user 102 manually delivers a compression, the ACD device 100shown here is an example of a manual ACD device. Other types ofmechanical ACD devices can be used with the techniques described below,e.g., the techniques for determining a neutral position of chestcompression. Although the ACD device 100 shown here includes a handleand a suction cup, other types of ACD devices used with the techniquesdescribed below need not include these elements. For example, othertypes of ACD devices may include a first element configured to beaffixed to a surface of a patient's body and a second element configuredto be coupled to a hand of a rescuer. In these examples, the firstelement allows for pulling upward on the patient's body surface whilemaintaining contact with the patient's body surface. Further, in theseexamples, the second element enables the rescuer to push on the chestand pull up the chest.

A suction cup and handle are examples of the first element and thesecond element, respectively, but are not the only types of theseelements that can be used. For example, the first element could includeone or more assemblies of multiple suction cups, or the first elementcould be a surface partially or fully covered by an adhesive (e.g.,adhesive gel) that affixes to a patient's chest, or the first elementcould be a combination of any of these things. Examples of assemblies ofmultiple suction cups are described in U.S. Pat. No. 8,920,348, titled“Method and Device for Performing Alternating Chest Compression andDecompression,” incorporated by reference in its entirety. The secondelement could include one or more straps or brackets that hold therescuer's hand tightly against the ACD device, instead of or in additionto the handle described above.

FIG. 2 represents the change in shape of the chest 200 of a patient 104as the ACD device 100 is used to perform ACD CPR. Because the chest 200of a human being is not rigid, the chest will change shape in responseto forces applied. When the sternum is compressed downward 202 in the CNphase, the chest 200 tends to exhibit a shape 204 that is compressed inthe anterior-posterior (AP) dimension 206 and extended in the lateraldimension 208. This shape 204 is sometimes referred to as a compressionshape. During the DE phase 210, the chest 200 tends to exhibit a shape212 that is extended in the AP dimension 206 and narrower in the lateraldimension 208. This shape 212 is sometimes referred to as adecompression shape. The chest 200 exhibits a shape 214 corresponding toa neutral position of chest compression, when no force is applied eitherupwards or downwards. In other words, the shape 214 corresponds to thenatural position of the chest when its shape is not substantiallyaffected by a force applied, e.g., during CPR chest compressions.

Chest compliance is the mathematical description of this tendency tochange shape as a result of an applied force. It is the inverse ofstiffness. It is the incremental change in depth divided by theincremental change in force at a particular instant in time. In the caseof a chest compression cycle, the compliance may be plotted with time onthe abscissa as shown in FIG. 3, or alternatively, the compliance may beplotted as a loop with depth as the independent variable and the timevariable implied in the loop trajectory, as shown in FIGS. 5 and 6. If apatient's chest exhibits relatively little change in shape in responseto a particular change of force, the patient has relatively low chestcompliance. In contrast, if the patient's chest exhibits relatively highchange in shape in response to a particular change of force, the patienthas relatively high chest compliance. In addition, chest compliancevaries as the chest is compressed as a result of the structural changesof the thoracic cavity due to positional/conformational changes as thechest is compressed downwards and pulled upwards. This is describedbelow with respect to FIGS. 5 and 7. For example, as the chest iscompressed downward, the compliance of the chest decreases as the chestapproaches the limits of its flexibility, e.g. region 508 or the flatregion on the right side of the curve of FIG. 7.

For each point in time, n, for which a displacement measurement is takenby the system, a force measurement is also taken, resulting in adisplacement/force vector-pair for each sample time n, [d_(n), f_(n)].In general, compliance, c, equals the change in displacement divided bythe change in pressure, compared to a reference time point: c=Δd/Δp.

“Instantaneous Compliance” (IC) refers to when the reference time point,t₀, is adjacent or nearly adjacent to the time point, t₀, and is thusmore a measure of the slope of the displacement-force curve, at aparticular point in time. For instance, the reference time point, t₀,may be the sample time point immediately preceding time, t_(n). Thereference time point may be composed on multiple sample pointsimmediately preceding time, t_(n), for instance using a moving average,weighted moving average or low pass filter, known to those skilled inthe art. There may be a small gap in time between the reference timepoint and time, t_(n), for instance 1 second or less. In some versions,the reference time point may be chosen to be the beginning of a segment,for instance the beginning of the compression for Slope 1 (the firstsegment in the compression, and thus the segment start is also thecompression start) in FIG. 6B or the dotted line for reference time t₀for Slope 2 in the same figure.

Instantaneous Compliance InC_(n)=|(d _(n) −d _(r))/(p _(n) −p _(r))|

Where InC_(n) is the estimate of the slope of the distance/pressurecurve at a point in time, t_(n); d_(n) is the displacement at time,t_(n); p_(p) is the pressure at time t_(n); and d_(r) and p_(r) are thedistance and pressure at the reference time, t_(r), respectively.

“Absolute Compliance” (AC), on the other hand, refers to when thereference point, t₀, uses an absolute reference such as the pressure anddisplacement at the very start of a group of chest compressions. DuringCPR, there may be what are termed “rounds” of chest compressions whichare periods of approximately 1-3 minutes where chest compressions aredelivered, and then at the end of the time period, compressions arehalted and various other therapeutic actions may be performed, such asanalyzing the patients ECG, delivering a defibrillation shock ordelivering a drug such as epinephrine or amiodarone. Thus fordetermination of AC, reference point, t₀, prior to the beginning of anyof the rounds of chest compressions, including prior to the first roundof compression, i.e. at the beginning of CPR. In most instances, thepressure will be zero at this point in time, and the displacement willbe effectively calibrated to zero by the displacement estimationsoftware. The Absolute Compliance of the chest can be estimated from thecompression displacement and the related compression pressure. Thereference pressure “p₀” is the pressure at time, t₀, and chestdisplacement “d₀” is the displacement at time, t₀. The pressure “p_(n),”is the pressure required to achieve the displacement “d_(n)”. The chestcompliance is estimated from the following equation:

Absolute Compliance=|(d _(p) −d ₀)/(p _(p) −p ₀)|

Where d_(p) is the displacement at the peak of the compression and p_(p)is the pressure at the peak of the compression.

The compliance and compression depth of the chest 200 can be measured bysensors 216 a-c in the device 100. For example, a force sensor 216 a anda motion sensor such as an accelerometer 216 b can be used. In someimplementations, the force sensor 216 a and the accelerometer 216 b areplaced in a housing 218 of the device 100. The accelerometer senses themotion of the chest during CPR and the force sensor measures the forceor pressure applied. The accelerometer signal is integrated to determinethe displacement of the housing 218, and the output of the force sensoris converted to standard pressure or force units.

In some implementations the accelerometer is in a separate housing, forexample a housing placed on the sternum of the patient, and the forcesensor is in a housing, e.g. housing 218 of the device 100. In such animplementation the housing containing the accelerometer and the devicewith the force sensor may be configured to be attached or connectedduring CPR.

In some implementations, multiple accelerometers 216 b, 216 c can beused. For example, the second accelerometer 216 c can be placed on thepatient's sternum in the inner perimeter or near the suction cup 112.The second accelerometer may be contained in a separate assembly ofself-adhesive foam such as the ZOLL CPR Stat-Padz (Chelmsford, Mass.).In this way, the first accelerometer 216 b tends to measure accelerationexperienced by the rescuer's hands 102 (FIG. 1), and the secondaccelerometer 216 c tends to measure acceleration of the patient'ssternum 104. Put another way, the first accelerometer 216 a may beconfigured to measure movement arising from an applied upward force,e.g., because the first accelerometer 216 a is proximate or otherwisemechanically coupled to the suction cup 112, it provides a suitableindication of force applied as the suction cup 112 pulls up on thepatient's sternum. Further, the second accelerometer 216 b may measuremovement arising from an applied downward force, e.g., because thesecond accelerometer 216 b is proximate or otherwise mechanicallycoupled to the handle of the device 100, the second accelerometer 216 bprovides a suitable indication of downward force applied by therescuer's hand. In this fashion, the system can detect if the isinsufficient adherence between the ACD device and the patient's sternumand alert the rescuer to re-apply the ACD device to the patient's chest.

FIG. 3 represents signals recorded during CPR, e.g., using the sensors214 a-c shown in FIG. 2. Though Absolute Compliance may be used todetermine the neutral position, InC will provide a more accurate measureof the neutral position.

Compressions (C1-C5) can be detected from the displacement signal. Thecompression rate is calculated from the interval between compressions(e.g. (time of C2−time of C1)), and compression depth is measured fromthe compression onset to peak displacement (e.g. (d1−d0)). The onset andpeak compression values are saved for each compression. The pressures atthe compression onset and offset are used to determine the force used toachieve a given compression depth. Chest compliance is further describedin U.S. Pat. No. 7,220,235, titled “Method and Apparatus for Enhancementof Chest Compressions During CPR,” issued May 22, 2007, and is herebyincorporated by reference in its entirety. Compression velocity anddisplacement can be estimated via such methods as described in U.S. Pat.Nos. 8,862,228 6,827,695, and 6,390,996, each hereby incorporated byreference in its entirety.

FIG. 4 is a block diagram of components of the ACD device 100 shown inFIG. 1. The device includes a processor 400, e.g., an electroniccomponent such as a microprocessor that carries out instructions, e.g.,processes input data to generate output data, and communicates data toand from other components of the device 100. For example, the processor400 receives signals from sensors such as the force sensor 402 andmotion sensors such as accelerometers 404 a, 404 b (or, in someimplementations, a single accelerometer). Other types of motion sensorsmay include magnetic induction based systems such as described in U.S.Pat. No. 7,220,235, mentioned above.

The processor 400 also communicates output information 406 to a userinterface module 408. The output information 406 is indicative of theeffectiveness of a CPR treatment and is determined by the processor 400in part based on signals received from the sensors, e.g., force sensor402 and accelerometers 404 a, 404 b.

The user interface module 408 can take one of several forms. In someimplementations, the user interface module 408 is a combination ofsoftware and hardware and includes a display that presents informationto a user of the device 100. For example, the information presented caninclude textual information and graphical information such as graphs andcharts. The user interface module can also include other components suchas input devices, e.g., buttons, keys, etc. In some implementations, theuser interface module includes audio input/output elements, e.g., amicrophone, speaker, and audio processing software.

In some implementations, the user interface module 408 causes a userinterface to appear on an external device 412, e.g., a device that iscapable of operating independent of the ACD device 100. For example, theexternal device could be a smartphone, tablet computer, or anothermobile device. The external device could also be a defibrillator such asthe ZOLL Medical Corp X-Series defibrillator (Chelmsford Mass.) with anaccelerometer built into the defibrillation pads (CPR Stat-Padz), orother self-adhesive assembly containing a motion sensor that is adheredto the patient's sternum and measures primarily the motion of thepatient's sternum. This assembly may or may not be integrated with thedefibrillation electrodes. The defibrillator may receive theacceleration or motion data from the ACD device and compare the motionof the ACD sensor and compare it to the accelerometer or motioninformation from the accelerometer from the defibrillation pad or otheradhered sternal motion-sensing assembly. If the two motions are found todiffer by more than 0.25 in., for example, particularly during thedecompression phase of the compression cycle, the rescuer may beprompted to reapply the ACD device.

In some implementations, the external device 412 communicates with theACD device 100 using a wireless communication technique such asBluetooth. In this example, the ACD device 100 has a wirelesscommunication module 410. For example, the user interface module 408 maycommunicate signals to and from the external device 412 using thewireless communication module 410. Although Bluetooth is used as anexample here, other wireless communications techniques could be used,such as WiFi, Zigbee, 802.11, etc.

In some implementations, the processor 400 can perform calculations todetermine an estimate of chest compliance 414, e.g., using the equationsdescribed above with respect to FIG. 2.

In some implementations, the processor 400 can perform calculations todetermine if a patient's chest was substantially released between twocompressions (i.e., released sufficiently to create a pressure in thechest that facilitates venous filling of the heart). The user interfacemodule 408 can cause a user interface 106 (FIG. 1) of the device 100 todisplay messages that give guidance or other feedback to the user 102(FIG. 1), e.g., to more completely release the chest betweencompressions and/or to push harder on the chest during compression.

The processor 400 can further calculate an estimated neutral position ofchest compression 416, e.g., based on data such as the estimated depthof chest compression and the estimate of chest compliance 414. Thecalculation can be based in part on a feature of a compliancerelationship as described below in further detail with respect to FIGS.5 and 6.

The output information 406 can include information determined based onthe estimate of chest compliance 414 and the neutral position of chestcompression 416. For example, the output information 406 could includeinformation such as a compression non-elevated (CN) depth ordecompression elevated (DE) height. The output information 406 can alsoinclude feedback to the user about adjusting the user's actions in a waythat would increase the effectiveness of a CPR treatment. Examples aredescribed below with respect to FIG. 7.

In some implementations, the processor 400 compares signals received bythe first accelerometer 404 a and the second accelerometer 404 b. Asdescribed above with respect to FIG. 2, the first accelerometer 404 acan be placed in or near a housing of the ACD device 100, and the secondaccelerometer 404 b can be placed in or near a suction cup 112 of theACD device 100. In this way, the first accelerometer 216 b tends tomeasure acceleration experienced by the user 102 (FIG. 1), and thesecond accelerometer tends to measure acceleration experienced by thepatient 104. In some implementations, multiple accelerometers 216 b, 216c can be used. For example, the second accelerometer 216 c can be placedon the patient's sternum in the inner perimeter or near the suction cup112. The second accelerometer may be contained in a separate assembly ofself-adhesive foam such as the ZOLL CPR Stat-Padz (Chelmsford, Mass.).In this way, the first accelerometer 216 b tends to measure accelerationexperienced by the rescuer's hands 102 (FIG. 1), and the secondaccelerometer 216 c tends to measure acceleration of the patient'ssternum 104. In this fashion, the system can detect if there isinsufficient adherence between the ACD device and the patient's sternumand alert the rescuer to re-apply the ACD device to the patient's chest.

In some implementations, the processor 400 includes or has access to amemory 418 that can store data. The memory 418 can take any of severalforms and may be integrated with the processor 400 (e.g., may be part ofthe same integrated circuit) or may be a separate component incommunication with the processor 400 or may be a combination of both. Insome implementations, the memory 418 stores data such as values for theestimate of chest compliance 414 and the neutral position of chestcompression 416 as they are calculated by the processor 400. In someimplementations, the processor 400 uses the memory 418 to store data forlater retrieval, e.g., stores data during an administration of CPR forretrieval later during the same administration of CPR or for retrievallater during a different administration of CPR.

FIG. 5 shows an example graph 500 including a chest compliance curve502. In some implementations, the compliance curve 502 is arepresentation of data calculated by the processor 400 (FIG. 4) based oninput received from sensors, e.g., a force sensor and/oraccelerometer(s). The graph 500 shown in FIG. 5 includes an x-axisrepresenting time (e.g., in seconds) and a y-axis representing chestcompliance. The curve 502 exhibits a sinusoidal shape. This kind ofcompliance curve 502 is sometimes called a non-hysteresis compliancecurve.

In practical terms, when a rescuer is performing CPR on a victim usingan ACD device (e.g., the device 100 shown in FIG. 1), the rescuer causesdownward and upward forces to be exerted on the chest of the victim. Thevictim's chest compliance will be lowest as the forces cause the shapeof the chest to approach its natural limits. In other words, thevictim's chest compliance approaches a lower limit as it is pulled up orpulled down. In some scenarios, when the chest compliance approachesthis lower limit it is an indication that the tensile strength of theribs have been reached, and that if additional force is exerted, one ormore ribs have an elevated risk of fracturing. In some versions of thesystem, a warning may be provided in the form of audio, visual ortactile/haptic prompts indicating that the compliance has been reducedbelow some threshold level.

FIG. 6A shows representative stiffness curves for sternal impact, andFIG. 6B shows stiffness regions of the curves. Referring to thesefigures, the slopes of the representative curves are the stiffness(e.g., the inverse of compliance). Each of the loops is the curve for adifferent subject. Slope 1 in FIG. 6B is the stiffness for the CN phaseof the compression; it is a lower slope value and less stiff (and thushigher compliance). Though the slopes for the CN phase of compressionfor each subject varies as seen in the multiple loops in the figure, inmost if not all cases, there will be a change in slope to a second,steeper slope (lower compliance, and more stiff) at some inflectionpoint during the compression, represented by the shift to Slope 2.

At the inflection point represented by the intersection of the twolines, Slope 1 and Slope 2 in the figure, the risk of fracturing isstill relatively low. Once the inflection point has been detected, thesystem can prompt the rescuer to maintain that compression depth, as itis still in the safe range. This patient-specific compression depth willlikely be different that AHA/ILCOR Guidelines (e.g. more than 2 inches).For instance, initially at the start of the resuscitation efforts, thepatient's chest may be much stiffer, particularly for elderly patients,where their sternal cartilage attaching the sternum to the ribs hascalcified and stiffened. If the rescuer were to try and delivercompressions at a depth recommended by the AHA/ILCOR Guidelines, theywould likely cause rib fractures in the patient. In fact, in theGuidelines statement themselves, it is acknowledged that rib fracturesare a common occurrence using existing chest compression methods. “Ribfractures and other injuries are common but acceptable consequences ofCPR given the alternative of death from cardiac arrest.” (From the 2005International Consensus Conference on Cardiopulmonary Resuscitation andEmergency Cardiovascular Care Science with Treatment Recommendations,hosted by the American Heart Association in Dallas, Tex., Jan. 23-30,2005.) Aside from the discomfort of the nosocomial rib fractures, anunfortunate side effect of the rib fractures is that they result inreduced resilience of the chest wall and thus a reduction in the naturalrecoil of the chest during the decompression phase resulting in areduced venous return and degraded chest compression efficacy. It isdesirable to minimize or eliminate rib fractures for these reasons. Bydetecting changes in the chest wall compliance, and prompting therescuer as a result of those detections, chest compression depth willnot exceed the injury threshold of ribs and sternum.

Because the neutral position as well as the overall compliance of thechest varies over the course of the resuscitation effort, the depth towhich the rescuer is being guided by the real-time prompting of thesystem will also vary using this approach. A phenomena known aschest-wall remodeling occurs during the initial minutes subsequent tothe initiation of chest compressions. AP diameter may decrease by asmuch as 0.5-1 inch, and compliance of the chest wall will increase asthe sternal cartilage is gradually softened. By staying within thesafety limits in a customized fashion for each individual patient foreach compression cycle as the chest gradually softens, injuries arereduced, but more importantly, the natural resilience of the chest wallis maintained and more efficacious chest compressions are delivered tothe patient.

Generally speaking, methods for detecting the change in slope caninclude determining initial statistical characteristics of the slope ofthe CE phase, and then analyzing the slope for any significant,sustained increase in slope. For instance, techniques can be used suchas change point analysis such as that described by Basseville(Basseville M, Nikiforov I V. Detection of Abrupt Changes: Theory andApplication. Engelwood, N.J.: Prentice-Hall 1993) or Pettitt (PettittAN) A simple cumulative sum type statistic for the change point problemwith zero-one observations. (Biometrika 1980; 67:79-84.) Other methodssuch as Shewhart control charts may be employed for first detectingchanges in the slope and then assessing whether the change detected isboth an increase and of a sufficient magnitude to generate a prompt tothe rescuer indicating that the depth of compression is too deep, and insome way to compress less deeply for future compressions. In simplerversions, prompting may be initiated when the compliance decreases belowsome percentage threshold below the initial compliance values at thestart of a particular compression, e.g. 15% reduction in compliance. Theinitial compliance value may be averaged over more than one compressionphase; it may be used as a comparative value for multiple compressioncycles.

In some embodiments, separate tests may be performed on compliance todetermine risk of injury during both the DE phase and the CN phase (i.e.at the top of the decompression portion [DN and DE phases] of thecompression cycle and the bottom of the compression portion [CE and CNphases] of the compression cycle.)

In contrast, when the victim's chest is at a neutral position of chestcompression (generally corresponding to the natural resting position ofthe chest), chest compliance tends to be at its highest point. Thus, inthe curve 502 shown in FIG. 5, the points 504, 506 corresponding to thehighest chest compliance (e.g., the peaks of the sinusoid) tend tocorrespond to the neutral position of chest compression. In contrast,the points 508 correspond to the lowest chest compliance (e.g., thetroughs of the sinusoid) tend to correspond to the limits of the chest'scompression shape or decompression shape.

In some implementations, the processor 400 (FIG. 4) can use a feature ofthe non-hysteresis compliance curve 502 to calculate an estimate of theneutral position of chest compression 416 (FIG. 4). For example, theprocessor 400 can use peaks 504, 506 of the curve 502 to calculate anestimate of the neutral position of chest compression.

FIG. 7 shows an example graph 600 including a chest compliance curve 602that forms a hysteresis loop. This kind of compliance curve 602 issometimes called a hysteretic compliance curve. In some implementations,the compliance curve 502 is a representation of data calculated by theprocessor 400 (FIG. 4) based on input received from sensors, e.g., aforce sensor and/or motion sensor(s), e.g. accelerometer(s). The graph600 shown in FIG. 7 includes an x-axis representing depth (e.g., incentimeters) and a y-axis representing chest compliance. The arrows onthe curve show the progress of time during the course of one compressioncycle, and represent the motion of the ACD device 100 (FIG. 1), forinstance, the portion of the curve with the arrows pointing to the rightshow the instantaneous compliance (IC) for the compression portion (CEand CN) of the compression cycle, and the portion of the curve withleftward-facing arrows show the instantaneous compliance (IC) for thedecompression portion (DE and DN) of the compression cycle. For example,when the ACD device 100 moves from a high depth to a low depth, chestcompliance increases (as the chest approaches a neutral position ofcompression) and then decreases (as the chest becomes more compressed).Then, when the ACD device 100 moves from its lowest depth back to a highdepth, chest compliance again increases (as the chest approaches aneutral position of compression) and again decreases (as the chestbecomes more decompressed).

In some implementations, the processor 400 (FIG. 4) can use a feature ofthe hysteresis compliance curve 602 to calculate an estimate of theneutral position of chest compression 416 (FIG. 4). One of severalfeatures could be used.

For example, the point 604 of intersection of the hysteresis compliancecurve 602 can be used to estimate the neutral position of chestcompression 416. This point 604 represents a depth (e.g., as acoordinate of the x-axis) that may correspond to the neutral position ofchest compression.

As another example, a point 612 approximately halfway between two peaks614, 616 of the hysteresis compliance curve 602 can be used to estimatethe neutral position of chest compression 416. The point 612 can bedetermined, for example, by measuring the distance 610 between the peaks614, 616 and determining the point corresponding to the center of thedistance 610. Alternative, the neutral point may be a pointcorresponding to a predefined percentage of the distance 610.

As another example, a point 606 approximately halfway between otherfeatures of the hysteresis compliance curve 602 can be used to estimatethe neutral position of chest compression 416. For example, theprocessor could identify a distance 608 between two points of thehysteresis compliance curve 602 having the same value for compliance andthen the point 606 can be calculated by determining the pointcorresponding to the center of the distance 608.

FIG. 8 shows an example of a user interface 700. For example, the userinterface 700 may be an example of the user interface 106 of the ACDdevice shown in FIG. 1. Further, the user interface 700 may becontrolled by the user interface module 408 shown in FIG. 4.

The user interface 700 displays information 702 representingeffectiveness of a CPR treatment. The information 702 is displayed in amanner that enables a user 102 of the ACD device 100 (FIG. 1) toadminister the CPR treatment effectively.

The information 702 includes a graph 704 representing the DE height 706and CN depth 708 of the CPR treatment. The depth and height areseparated by a boundary 710. In some implementations, the DE height 706and CN depth 708 are determined by the processor 400 (FIG. 4). Forexample, the DE height 706 and CN depth 708 can be calculated usinginformation the accelerometer(s) 404 a-404 b and knowing the time ofoccurrence of the peak heights and depths along with the neutralposition. Alternatively, DE height and CN depth can be estimated fromthe force sensor 402 including calculated information such as theestimate of chest compliance 414 and the neutral position of chestcompression 416 determined by the processor 400. Alternatively, the DEportion 706 of the display feedback or the CN portion 708 may displaymeasurements of pressure rather than displacement. For instance, in oneembodiment, the DE portion 706 may display a measure of pressure orforce, DE force, while the CN portion 708 may display a measure ofdisplacement, CN depth.

Referring to FIG. 9, in some examples, a state transition diagram may beused to determine the phases of the compression cycle (e.g. CN, DN, DEand CE phases) based on inputs of compression direction (i.e. DE or CN)and whether the neutral point 416 has been reached. Transitions from CE904 to CN 902 phases and DN 906 to DE 908 phases with the detection of aneutral position (NP). Upon transition to either CN 902 or DE 908, NP isreset to 0, i.e. the transition is edge sensitive. Transitions ondirection are level sensitive. Transitions from CN 902 to DN 906 and DE908 to CE 904 occur on change in direction. Parameters descriptive ofthe motion, such as velocity, distance, average velocity, peak velocity,etc., may be calculated knowing the time of occurrence of the transitionbetween the compression phase states. In some versions, information 702may also include other motion information may be displayed, such asvelocity occurring during the decompression phase. More specifically,the velocity at the time that the neutral position occurs may bedisplayed, or otherwise communicated to the rescuer (e.g. tones, verbal,etc.). Alternatively, the velocity communicated to the rescuer may be anaverage or other statistical representation of the motion during asignificant portion of the decompression phase (both elevated andnon-elevated portions).

Referring to FIG. 8, the graph 704 also includes a DE height thresholdindicator 712 and a CN depth threshold indicator 714. These indicatorsprovide information to a user of the device about whether either or bothof the DE height and CN depth is too shallow or too deep. For example,if the user sees that the DE height 706 does not meet the thresholdindicator 712, the user can adjust his or her motion to increase the DEheight (e.g., by pulling the ACD device with greater force during the DEmotion). Similarly, if the user sees that the DE height indicator 706passes the threshold indicator 712, the user can adjust his or hermotion to decrease the DE height (e.g., by pulling the ACD device withless force during the DE motion). The user can similarly adjust theforce during the CN motion if the user sees that the CN depth 708 doesnot meet the threshold indicator 714.

Further, the information 702 can include guidance displayed to the userbased on the thresholds represented by the indicators 712, 714. Forexample, if either the DE depth or CN depth is not within a certainrange of the threshold (e.g., more than 10% greater or 10% less than thethreshold), then the user interface 700 can display messages guiding theuser. In the example shown in FIG. 8, the CN depth indicator 708indicates that the CN depth falls far short of the CN thresholdindicator 714. In response, the user interface 700 displays a message718 to the user indicating that he or she should push harder to reachoptimal compression. A similar message could be displayed (with respectto optimal decompression) if the DE height indicator 706 fell short ofits respective threshold. Similarly, if the DE height 706 or the CNdepth 708 passed its respective threshold by a substantial amount (e.g.,more than 10% past the threshold indicator), the user interface 700could display a warning message (e.g., “reduce CN force to avoidinjuring the patient”).

Alternatively, a miniature vibrator such as used in all cell phones, maybe included in the assembly in physical contact with the rescuer'shands, and haptic feedback about correct CN depth and DE height can becommunicated, e.g. it vibrates when the thresholds are achieved.

In the example shown in FIG. 8, the DE height indicator 706 is close tothe DE threshold indicator 712. Thus, the user interface 700 displays amessage 718 indicating that the user is using an appropriate amount offorce on DE motions.

In some implementations, the threshold indicators 712, 714 are displayedbased on thresholds that are static values. For example, the memory 418of the processor 400 (FIG. 4) may store static values, e.g., based onexperimental data about DE height and CN depth in patients. The staticvalues could be used directly, or the values may be modified by avariable measured with respect to the patient receiving the CPRtreatment.

In some implementations, the threshold indicators 712, 714 are displayedbased on thresholds calculated by a processor, e.g., the processor 400shown in FIG. 4. In some examples, the calculated thresholds are basedon a calculation of chest compliance, e.g., the estimate of chestcompliance 414 shown in FIG. 4. For example, referring to the compliancecurve 602 shown in FIG. 7, values of depth corresponding to the lowestvalues of chest compliance may correspond to the maximum DE height andmaximum CN depth.

In some implementations, the user interface 700 shows a trend graphrepresenting chest remodeling. For example, the trend graph canrepresent what happens to the patient's chest over the course of a CPRtreatment. FIG. 10 shows an example of the trend graph 1000 that couldbe displayed on the user interface 700. The trend graph 1000 has anx-axis 1002 representing time and a y-axis 1004 representing compliance.As shown in the example in the figure, the trend graph 1000 can includea zero point trend line 1006 (e.g., a trend line representing a startingdepth of the patient's chest) and a compliance trend line 1008. Overtime, the zero point and the compliance change as a CPR treatment isdelivered, as represented by the trend graph.

FIG. 11 is a block diagram of an example computer system 1100. Forexample, referring to FIG. 1, the ACD device 100 could be an example ofthe system 1100 described here, as could the external device 412 (FIG.4). The system 1100 includes a processor 1110, a memory 1120, a storagedevice 1130, and one or more input/output interface devices 1140. Eachof the components 1110, 1120, 1130, and 1140 can be interconnected, forexample, using a system bus 1150.

The processor 1110 may be an example of the processor 400 shown in FIG.4 and is capable of processing instructions for execution within thesystem 1100. The term “execution” as used here refers to a technique inwhich program code causes a processor to carry out one or more processorinstructions. In some implementations, the processor 1110 is asingle-threaded processor. In some implementations, the processor 1110is a multi-threaded processor. In some implementations, the processor1110 is a quantum computer. The processor 1110 is capable of processinginstructions stored in the memory 1120 or on the storage device 1130.The processor 1110 may execute operations such as determining a neutralposition of chest compression based at least in part on a feature of acompliance curve.

The memory 1120 stores information within the system 1100. In someimplementations, the memory 1120 is a computer-readable medium. In someimplementations, the memory 1120 is a volatile memory unit. In someimplementations, the memory 1120 is a non-volatile memory unit.

The storage device 1130 is capable of providing mass storage for thesystem 1100. In some implementations, the storage device 1130 is anon-transitory computer-readable medium. In various differentimplementations, the storage device 1130 can include, for example, ahard disk device, an optical disk device, a solid-date drive, a flashdrive, magnetic tape, or some other large capacity storage device. Insome implementations, the storage device 1130 may be a cloud storagedevice, e.g., a logical storage device including one or more physicalstorage devices distributed on a network and accessed using a network.In some examples, the storage device may store long-term data. Theinput/output interface devices 1140 provide input/output operations forthe system 1100. In some implementations, the input/output interfacedevices 1140 can include one or more of a network interface devices,e.g., the wireless communication module 410 shown in FIG. 4, or anEthernet interface, a serial communication device, e.g., an RS-232interface, and/or a wireless interface device, e.g., an 802.11interface, a 3G wireless modem, a 4G wireless modem, etc. A networkinterface device allows the system 1100 to communicate, for example,transmit and receive data. In some implementations, the input/outputdevice can include driver devices configured to receive input data andsend output data to other input/output devices, e.g., keyboard, printerand display devices 1160. In some implementations, mobile computingdevices, mobile communication devices, and other devices can be used.

Referring to FIG. 4, steps carried out by the processor 400 can berealized by instructions that upon execution cause one or moreprocessing devices to carry out the processes and functions describedabove, for example, determining information relevant to a CPR treatment.Such instructions can include, for example, interpreted instructionssuch as script instructions, or executable code, or other instructionsstored in a computer readable medium.

A computer system 1100 can be distributively implemented over a network,such as a server farm, or a set of widely distributed servers or can beimplemented in a single virtual device that includes multipledistributed devices that operate in coordination with one another. Forexample, one of the devices can control the other devices, or thedevices may operate under a set of coordinated rules or protocols, orthe devices may be coordinated in another fashion. The coordinatedoperation of the multiple distributed devices presents the appearance ofoperating as a single device.

In some examples, the system 1100 is contained within a singleintegrated circuit package. A system 1100 of this kind, in which both aprocessor 1110 and one or more other components are contained within asingle integrated circuit package and/or fabricated as a singleintegrated circuit, is sometimes called a microcontroller. In someimplementations, the integrated circuit package includes pins thatcorrespond to input/output ports, e.g., that can be used to communicatesignals to and from one or more of the input/output interface devices1140.

Although an example processing system has been described in FIG. 11,implementations of the subject matter and the functional operationsdescribed above can be implemented in other types of digital electroniccircuitry, or in computer software, firmware, or hardware, including thestructures disclosed in this specification and their structuralequivalents, or in combinations of one or more of them. Implementationsof the subject matter described in this specification, such as storing,maintaining, and displaying artifacts can be implemented as one or morecomputer program products, i.e., one or more modules of computer programinstructions encoded on a tangible program carrier, for example acomputer-readable medium, for execution by, or to control the operationof, a processing system. The computer readable medium can be a machinereadable storage device, a machine readable storage substrate, a memorydevice, or a combination of one or more of them.

The term “system” may encompass all apparatus, devices, and machines forprocessing data, including by way of example a programmable processor, acomputer, or multiple processors or computers. A processing system caninclude, in addition to hardware, code that creates an executionenvironment for the computer program in question, e.g., code thatconstitutes processor firmware, a protocol stack, a database managementsystem, an operating system, or a combination of one or more of them.

A computer program (also known as a program, software, softwareapplication, script, executable logic, or code) can be written in anyform of programming language, including compiled or interpretedlanguages, or declarative or procedural languages, and it can bedeployed in any form, including as a standalone program or as a module,component, subroutine, or other unit suitable for use in a computingenvironment. A computer program does not necessarily correspond to afile in a file system. A program can be stored in a portion of a filethat holds other programs or data (e.g., one or more scripts stored in amarkup language document), in a single file dedicated to the program inquestion, or in multiple coordinated files (e.g., files that store oneor more modules, sub programs, or portions of code). A computer programcan be deployed to be executed on one computer or on multiple computersthat are located at one site or distributed across multiple sites andinterconnected by a communication network.

Computer readable media suitable for storing computer programinstructions and data include all forms of non-volatile or volatilememory, media and memory devices, including by way of examplesemiconductor memory devices, e.g., EPROM, EEPROM, and flash memorydevices; magnetic disks, e.g., internal hard disks or removable disks ormagnetic tapes; magneto optical disks; and CD-ROM, DVD-ROM, and Blu-Raydisks. The processor and the memory can be supplemented by, orincorporated in, special purpose logic circuitry. Sometimes a server(e.g., is a general purpose computer, and sometimes it is acustom-tailored special purpose electronic device, and sometimes it is acombination of these things. Implementations can include a back endcomponent, e.g., a data server, or a middleware component, e.g., anapplication server, or a front end component, e.g., a client computerhaving a graphical user interface or a Web browser through which a usercan interact with an implementation of the subject matter described isthis specification, or any combination of one or more such back end,middleware, or front end components. The components of the system can beinterconnected by any form or medium of digital data communication,e.g., a communication network. Examples of communication networksinclude a local area network (“LAN”) and a wide area network (“WAN”),e.g., the Internet.

A number of embodiments of the invention have been described.Nevertheless, it will be understood that various modifications may bemade without departing from the spirit and scope of the invention.Accordingly, other embodiments are within the scope of the followingclaims.

1-30. (canceled)
 31. A method for assisting with cardiopulmonaryresuscitation (CPR) administered to a patient using an activecompression-decompression device, the method comprising: receiving, fromat least one motion sensor and from at least one force sensor, datarecorded during administration of active compression-decompressions tothe chest of the patient by the active compression-decompression device;calculating a chest compliance relationship during the activecompression-decompressions involving displacement and force based on thedata received from the at least one motion sensor and the at least oneforce sensor; estimating a neutral position of the chest for a cycle ofthe active compression-decompressions as the activecompression-decompressions of the cycle are administered, the neutralposition of the chest being based at least in part on a feature of thechest compliance relationship; and adjusting one or more applicationparameters of the active compression-decompression device based on theneutral position of the chest.
 32. The method of claim 31, wherein thecycle comprises a continuous variation from a non-elevated chestposition to an elevated decompressed chest position.
 33. The method ofclaim 32, wherein the one or more application parameters comprise atleast one of displacement, velocity, acceleration, time, work, power,pressure, direction and orientation.
 34. The method of claim 32, whereinthe one or more application parameters comprise a distance above theneutral position of the chest and a depth of compression below theneutral position of the chest.
 35. The method of claim 31, wherein theneutral position of the chest corresponds to a transition phase of thecycle of the active compression-decompressions during which the forceapplied to the chest is substantially zero.
 36. The method of claim 31,wherein the chest compliance relationship defines a compliance curve.37. The method of claim 36, wherein the compliance curve comprises ahysteresis compliance curve illustrating a chest compliance relative toa chest compression displacement.
 38. The method of claim 37, whereinthe feature of the hysteresis compliance curve comprises a point ofintersection of subsequent hysteresis compliance curves.
 39. The methodof claim 36, wherein the feature of the compliance curve comprises apoint approximately halfway between two peaks of two compliance curves.40. The method of claim 36, wherein the compliance curve comprises anon-hysteresis compliance curve.
 41. The method of claim 36, wherein thefeature comprises a peak of the compliance curve.
 42. The method ofclaim 31, wherein adjusting one or more application parameters of theactive compression-decompression device based on the neutral position ofthe chest comprises: increasing the one or more application parametersof the active compression-decompression device; or decreasing the one ormore application parameters of the active compression-decompressiondevice.
 43. The method of claim 31, wherein adjusting one or moreapplication parameters of the active compression-decompression devicebased on the neutral position of the chest comprises providing an outputfor a user to adjust the one or more application parameters.
 44. Themethod of claim 31, wherein the data recorded during administration ofthe active compression-decompressions to the chest of the patientcomprises a pressure measurement.
 45. The method of claim 31, whereinthe data recorded during administration of the activecompression-decompressions to the chest of the patient comprises adisplacement signal.
 46. The method of claim 31, wherein the datarecorded during administration of the active compression-decompressionsto the chest of the patient comprises information for determiningwhether at least one transition point of the CPR has been reached. 47.The method of claim 46, wherein the at least one transition point is atleast one of between an elevated compression phase and a non-elevatedcompression phase, between an elevated decompression phase and theelevated compression phase, between the elevated decompression phase anda hold time above the neutral position of the chest, and between a holdtime above the neutral position of the chest and the elevatedcompression phase.
 48. The method of claim 46, wherein the at least onetransition point is at least one of between a non-elevated compressionphase and a non-elevated decompression phase, between the non-elevatedcompression phase and a hold time below the neutral position of thechest, and between hold time below the neutral position of the chest andthe non-elevated decompression phase.
 49. The method of claim 46,wherein the at least one transition point is between a non-elevateddecompression phase and an elevated decompression phase.
 50. The methodof claim 31 comprising: identifying a potential for injury of a patientundergoing CPR, the identification based at least in part on the featureof the chest compliance relationship.
 51. The method of claim 50,wherein a reduction in compliance below a predetermined thresholdindicates the potential for injury of the patient undergoing CPR. 52.The method of claim 31 comprising: applying a negative pressure on thechest of the patient.
 53. The method of claim 31, wherein the neutralposition of the chest comprises a first neutral position of the chestcorresponding to a first chest compression of the chest that isdifferent from a second neutral position of the chest corresponding to asecond chest compression that is subsequent to the first chestcompression.
 54. A system for assisting with cardiopulmonaryresuscitation (CPR), the system comprising: an activecompression-decompression device configured to be affixed to a chest ofa patient, the active compression-decompression device being configuredto deliver active compression-decompressions to the chest of thepatient; at least one motion sensor operably coupled with the activecompression-decompression device; at least one force sensor operablycoupled with the active compression-decompression device; and one ormore processors and a non-transitory computer readable storage mediumencoded with a computer program comprising instructions that, whenexecuted, cause the one or more processors to perform operationscomprising: calculating a chest compliance relationship during theactive compression-decompressions involving displacement and force basedon data received from the at least one motion sensor and the at leastone force sensor, estimating a neutral position of the chest for a cycleof the active compression-decompressions as the activecompression-decompressions of the cycle are administered, the neutralposition of the chest being based at least in part on a feature of thechest compliance relationship, and adjusting one or more applicationparameters of the active compression-decompression device based on theneutral position of the chest.
 55. The system of claim 54, wherein thecycle comprises a continuous variation from a non-elevated chestposition to an elevated decompressed chest position.
 56. The system ofclaim 55, wherein the one or more application parameters comprise atleast one of displacement, velocity, acceleration, time, work, power,pressure, direction and orientation.
 57. The system of claim 55, whereinthe one or more application parameters comprise a distance above theneutral position of the chest and a depth of compression below theneutral position of the chest.
 58. The system of claim 54, wherein theneutral position of the chest corresponds to a transition phase of anactive compression-decompression CPR during which the force applied tothe chest is substantially zero.
 59. The system of claim 54, wherein thechest compliance relationship defines a compliance curve.
 60. The systemof claim 59, wherein the compliance curve comprises a hysteresiscompliance curve illustrating a chest compliance relative to a chestcompression displacement.
 61. The system of claim 60, wherein a featureof the hysteresis compliance curve comprises a point of intersection ofsubsequent hysteresis compliance curves.
 62. The system of claim 60,wherein the feature of the compliance curve comprises a pointapproximately halfway between two peaks of two compliance curves. 63.The system of claim 59, wherein the compliance curve comprises anon-hysteresis compliance curve.
 64. The system of claim 63, wherein thefeature comprises a peak of the non-hysteresis compliance curve.
 65. Thesystem of claim 54, wherein the active compression-decompression devicecomprises a suction cup and a handle.
 66. The system of claim 54,wherein the at least one force sensor provides an output convertible toa pressure measurement.
 67. The system of claim 54, wherein at least oneof the at least one motion sensor and the at least one force sensor arecomponents of the active compression-decompression device.
 68. Thesystem of claim 54, wherein the at least one motion sensor comprises anaccelerometer.
 69. The system of claim 54, wherein the at least onemotion sensor measures information for determining whether at least onetransition point of the CPR has been reached.
 70. The system of claim69, wherein the at least one transition point is at least one of betweenan elevated compression phase and a non-elevated compression phase,between an elevated decompression phase and the elevated compressionphase, between the elevated decompression phase and a hold time abovethe neutral position of the chest, and between a hold time above theneutral position of the chest and the elevated compression phase. 71.The system of claim 69, wherein the at least one transition point is atleast one of between a non-elevated compression phase and a non-elevateddecompression phase, between the non-elevated compression phase and ahold time below the neutral position of the chest, and between hold timebelow the neutral position of the chest and the non-elevateddecompression phase.
 72. The system of claim 69, wherein the at leastone transition point is between a non-elevated decompression phase andan elevated decompression phase.
 73. The system of claim 54, wherein theone or more processors are configured for identifying a potential forinjury of a patient undergoing CPR, the identification based at least inpart on the feature of the chest compliance relationship.
 74. The systemof claim 73, wherein a reduction in compliance below a predeterminedthreshold indicates the potential for injury of the patient undergoingCPR.
 75. The system of claim 54, wherein the system comprises animpedance threshold device configured to apply negative pressure on thechest of the patient.
 76. The system of claim 54, wherein the systemcomprises an adhesive pad configured to be adhered to at least a portionof a patient's chest.
 77. The system of claim 54, wherein the neutralposition of the chest comprises a first neutral position of the chestcorresponding to a first chest compression of the chest that isdifferent from a second neutral position of the chest corresponding to asecond chest compression that is subsequent to the first chestcompression.